Thread by @IvaCheung

For the next hour or so I’ll be tweeting from the BC Psychosocial Rehabilitation Advanced Practice webinar, "Using Tension-Based Practice to Promote Recovery-Orientation in the Inpatient Context." I’ll be using the hashtag #BCPSR if you want to follow along or mute!

The speaker today is Shu-Ping Chen, assistant professor of occupational therapy at the University of Alberta. She’s the author of “Recovery Education Program for Inpatient Mental Health Providers,” published by the Canadian Association of Occupational Therapists. #BCPSR

Recovery orientation thus far has been focused on community-based practice. This webinar will discuss applying recovery strategies to acute, inpatient settings. #BCPSR

Recovery concepts and strategies to promote recovery:
•Recovery is nonlinear. Setbacks can be be part of long-term recovery. Relapses are not failure
•Recovery means different things to different people; there is no right or wrong way to recover… #BCPSR

•Recovery is a person’s own responsibility. You can’t *do recovery* to someone. #BCPSR

3 Factors related to recovery:
1. Biological factors: psychiatric symptoms and side effects of medication.
2. Personal factors: hope, acceptance, positive sense of self, empowerment, control, personal responsibility, goals, coping skills: #BCPSR

3. Environmental factors: Quality of life, productivity, meaningful engagement, support, connection, stigma & discrimination #BCPSR

7 strategies to promote recovery:
1. Instil hope: develop a positive outlook in a given situation. Strengths based, set goals, emphasizing hope and possibilities instead of limitations, celebrate small successes #BCPSR

2. Develop interpersonal expertise: listening, positive self-disclosure
3. Empowerment: remove barriers, increase personal capacity, increase access to resources, provide support, provide availability of choices #BCPSR

4. Responsibility: encourage people to take responsibility for their own recovery—ask people to reflect on what things they did and can do for themselves #BCPSR

5. Therapeutic risk taking: shift view from risk control to risk management. Needs to be in therapeutic relationship, need plan to mitigate risks #BCPSR

6. Strength-based practice: use people’s strengths to achieve their goals; remove barriers
7. Peer support: Peer support workers offer emotional and social support founded on common experience #BCPSR

How recovery oriented is your current practice setting? Can use this tool to evaluate it: "Recovery Self-assessment (RSA-R) Administration/Manager version" (O’Connell et al 2007) #BCPSR

This tool helps you score the recovery orientation of your context to identify strengths and areas for improvement in several dimensions:
•Life goals
•Service user involvement
•Diversity of treatment options
•Choice
•Individually tailored services
•Inviting factors #BCPSR

Tension-practice-consequence model: addresses tensions inherent in delivering recovery-oriented services:
•Environmental: poor physical environment, unsafe atmosphere, etc.
•Personal: psychiatric symptoms, behavioural problems, cognitive impairment, etc. #BCPSR

•Providers: various recovery competencies, inefficient knowledge transmission, pressure, low motivation #BCPSR

*Tension* refers to situations in which service-providers are constrained in their ability to provide recovery-based practice. #BCPSR

10 major tensions
Tension 1: lack of agreement between patients’ needs/choices and the structure of the unit (e.g., ward rules and routines can be seen as rigid, but providers have to maintain order for patient safety) #BCPSR

Tension 2: challenges to ensuring human rights and delivering some interventions (e.g., search and seizure, use of behavioural contracts) #BCPSR

Tension 3: challenges in delivering services that are strength based in a context that is largely problem based #BCPSR

Tension 4: time restrictions on services that compromise the delivery of recovery-oriented services. High patient turnover means providers don’t have enough time to implement recovery planning. Providers are time restricted. #BCPSR

Tension 5: challenges related to share power with patients. There’s no doubt that providers hold the power; decision maker tends to be top-down. #BCPSR

Tension 6: Inpatient experience of acute illness or distress prevents them from engaging in activities associated with recovery. #BCPSR

Tension 7: challenges related to lack of colleague or system support delivery recovery-oriented services in the inpatient setting. #BCPSR

Tension 8: dilemmas when it’s believed that patients’ decisions may lead to harmful or negative outcomes—risk aversion. #BCPSR

Tension 9: dilemmas when patients are in a negative cycle of hopelessness or repeated relapse #BCPSR

Tension 10: dilemmas when stigmas prevent patients from moving forward, including internalized stigma and external stigma. #BCPSR

Tension-based practice: using tensions in practice to promote the integration of treatment and rehabilitation in a recovery-oriented system. Be aware of the complexities so that they can be addressed. #BCPSR

Lots of great suggestions to deal with these tensions on the slides, which will be available on the #BCPSR website in a week or so. I missed some because they went by really quickly…

But many of them involve considering the person's situation holistically, helping them articulate their needs, start a conversation to explain the institution's positions on rules and policies. #BCPSR

Host Dr. Regina Casey also says that OTs can be strong advocates and push for change in the clinical setting. There can be resistance among certain professionals. #BCPSR

Dr. Shu-Ping Chen emphasizes how important body language is in a clinician's approach. You may have to search a patient's possessions, but how you do it—and explaining why you're doing it—can help a patient maintain a feeling of respect and dignity. #BCPSR

A recovery orientation does not have to be more time consuming. If the system is built to facilitate it, it just becomes a way of being. #BCPSR

Some psychiatrists think recovery orientation is anti-psychiatry. It is not. But it is important to offer patients choices in their treatment plans. #BCPSR